Effective Acne Treatments Remain Elusive, Hopkins
Researchers Find

By David BrickerJHMI

After a half-century of looking at everything from Accutane
to zinc, dermatologists still can't prove which acne treatments
and drugs work best, a team at
Johns Hopkins Children's
Center finds after combing the scientific literature.

"One of the key questions for dermatologists has been, How
should we be treating acne in any given case?" says pediatrician
and medical informatics specialist Harold Lehmann. "Here we are
in the 21st century, and we still don't have a clear answer to
that question."

Lehmann and his co-authors document the dilemma in a
so-called evidence report for the U.S. Department of Health and
Human Services' Agency for Healthcare Research and Quality. The
reports are designed to give the public state-of-the-science
information about important health topics.

AHRQ asked Hopkins to analyze the relevant scientific
literature and identify the best drugs for treating acne and to
determine the strength of acne research findings based on
predetermined criteria. The team selected 250 English-language
studies that compared 150 acne drugs to each other or to a
placebo.

Each study was categorized and rated according to details of
how the study was performed, including how patients' acne was
assessed and if statistical significance was achieved in each
experimental comparison. After rating all the studies, the
research team found only 14 of the studies met their criteria for
a high "level of evidence," while the other 236 studies were
almost equally divided between middle and low levels of evidence
based on the group's criteria. "Some of the medicines in the
studies we looked at seemed to work quite well," Lehmann says.
"But it was impossible to say which medicines were the best for a
specific acne condition."

Lehmann suggests that a lack of research standards and a
deficiency of studies comparing drugs directly to each other
might be to blame for the lack of consensus on best acne
therapies.

"Dermatologists know a lot about acne," Lehmann says, "but
without standards and guidelines for dermatological research,
it's extremely hard to compare one study to another and learn
which treatments are best."

Lehmann will work with members of the American Association
of Pediatrics and the American Dermatological Society in May to
create research standards and guidelines dermatologists can
follow to help build consensus on favored acne treatments.

Funding for the report was provided by the U.S. Department
of Health and Human Services' Agency for Healthcare Research and
Quality. Other Hopkins researchers contributing to the report
were John Andrews, Karen Robinson, Victoria Holloway and Steven
Goodman.